A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer

Chun-Kai Fang, Ming-Chih Chang, Pei-Jan Chen, Ching-Chi Lin, Gon-Shen Chen, Johnson Lin, Ruey-Kuen Hsieh, Yi-Fang Chang, Hong-Wen Chen, Chien-Liang Wu, Kuan-Chia Lin, Yu-Jing Chiu, Yu-Chan Li, Chun-Kai Fang, Ming-Chih Chang, Pei-Jan Chen, Ching-Chi Lin, Gon-Shen Chen, Johnson Lin, Ruey-Kuen Hsieh, Yi-Fang Chang, Hong-Wen Chen, Chien-Liang Wu, Kuan-Chia Lin, Yu-Jing Chiu, Yu-Chan Li

Abstract

Purpose: This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention.

Methods: Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3.

Results: Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively.

Conclusions: Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.

Figures

Fig. 1
Fig. 1
a Depression used as mediating variable; b demoralization used as mediating variable. Note: *p < 0.05, ***p < 0.001
Fig. 2
Fig. 2
CART analysis to predict suicidal ideation

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